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General NPI Number Information
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NPI Number | 1538795406
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Entity Type | Individual
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Provider Name | MARINA FORSYTHE
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 8701 MAITLAND SUMMIT BLVD
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City | ORLANDO
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State | FL
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Zip | 32810-5915
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Country | US
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Telephone | 407-574-4629
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Fax |
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Provider Business Mailing Address
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Address Line | 631 WOODLAND ST
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-7318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-23-66776
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License Number State | FL
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